Robotic totally endoscopic coronary artery bypass: a word of caution implicated by a five-year follow-up

Robotic totally endoscopic coronary artery bypass of the left anterior descending artery has been introduced in the clinical setting using a wrist-enhanced computer-assisted device to provide a minimally invasive therapeutic approach. Early clinical results were focused on the initial hospital course of patients. This report describes the first 5-year follow-up of patients after totally endoscopic coronary artery bypass in a single center.

From May 1999 to June 2001, 41 patients (36 male, 5 female; mean age 60.6 +/- 8.9 years) underwent totally endoscopic coronary artery bypass for isolated high-grade lesions of the left anterior descending coronary artery by means of the da Vinci system (Intuitive Surgical, Inc, Mountain View, Calif). Clinical follow-up was performed 5 years after the operation. End points of the follow-up were freedom from major adverse events such as death, myocardial infarction, and repeated revascularization of the left anterior descending artery.

Hospital survival was 100%. Overall survival after 5 years was 92.7% (38/41 patients). Three (7.3%) patients died of noncardiac causes. Freedom from reintervention of the left anterior descending artery after a mean of 69 +/- 7.4 months was 87.2% (36/41 patients). Freedom from any major adverse events during the whole follow-up was 75.7% (31/41 patients).

Endoscopic surgery on the beating heart remains the ultimate goal for minimally invasive coronary artery surgery. The clinical outcomes and need for reintervention of the target vessel leave room for improvement and may be considered reflective of early experiences typically associated with dramatic departure from conventional therapy. Moving forward, advances in instrumentation and anastomotic technology seem to be essential for reproducible and reliable coronary anastomosis in a totally endoscopic approach.